Objectives: Appendiceal orifice lesions are occasionally detected during colonoscopy in patients with recurrent appendicitis. Conventional surgery with partial cecal resection may cause unnecessary trauma. Transcolonic endoscopic appendectomy (TEA) has been proposed as a minimally invasive alternative. We aimed to evaluate the feasibility, safety, and efficacy of transcolonic endoscopic appendectomy and to compare through-the-scope twin clips (TTS-TC) combined with metal clips versus metal clips alone for defect closure.
Methods: Twenty patients with recurrent appendicitis and no prior abdominal surgery who underwent transcolonic endoscopic appendectomy between December 2020 and December 2024 were included. Clinical and pathological variables, procedural parameters, and follow-up outcomes were analyzed. TTS-TC plus metal clips and metal clips alone for defect closure were compared.
Results: All procedures were technically and clinically successful. Postoperative time to resume diet and length of hospital stay were 4.05 and 6.40 days, respectively. TTS-TC combined with metal clips reduced suture time (18 min [interquartile range {IQR} 15.5–20 min] vs. 25 min [IQR 20–30 min]), procedure time (85 min [IQR 72.5–92 min] vs. 115 min [IQR 110–124 min]), and number of clips used (7 [IQR 6.5–8] vs. 8 [IQR 7–9]) compared with metal clips alone. No adverse events were reported. Colonoscopy performed at 3 months post-procedure showed no residual lesions or recurrence.
Conclusions: TEA is a feasible, safe, and effective approach for recurrent appendicitis with orifice lesions. It provides a minimally invasive dual-benefit strategy and can be facilitated by a novel closure method to streamline the procedure.
| [1] |
Y.-Y. Zhang, J.-Y. Lu, Q. Wang, and A.-M. Yang, “Resection of Polyps Involving the Appendiceal Orifice by Combined Endo-Laparoscopic Surgery: Two Case Reports,” World Journal of Gastrointestinal Surgery 16, no. 6 (2024): 1948–1952.
|
| [2] |
D. J. Tate, L. Desomer, H. Awadie, et al., “EMR of Laterally Spreading Lesions Around or Involving the Appendiceal Orifice: Technique, Risk Factors for Failure, and Outcomes of a Tertiary Referral Cohort (With Video),” Gastrointestinal Endoscopy 87, no. 5 (2018): 1279–1288.e2.
|
| [3] |
C. F. Justiniano, I. Ozgur, D. Liska, M. A. Valente, S. R. Steele, and E. Gorgun, “The Role of Advanced Endoscopy in Appendiceal Polyp Management and Outcomes,” Surgical Endoscopy 38, no. 4 (2024): 2267–2272.
|
| [4] |
T. Chen, A. Xu, J. Lian, Y. Chu, H. Zhang, and M. Xu, “Transcolonic Endoscopic Appendectomy: A Novel Natural Orifice Transluminal Endoscopic Surgery (NOTES) Technique for the Sessile Serrated Lesions Involving the Appendiceal Orifice,” Gut 70, no. 10 (2021): 1812–1814.
|
| [5] |
L. Guo, L. Ye, Y. Feng, et al., “Endoscopic Transcecal Appendectomy: A New Endotherapy for Appendiceal Orifice Lesions,” Endoscopy 54, no. 6 (2022): 585–590.
|
| [6] |
L. Wang, X.-Q. Li, Y.-F. Qu, et al., “Feasibility of a Novel Unassisted Single-Channel Transcolonic Endoscopic Appendectomy for the Treatment of Appendiceal Lesions (With Video),” Surgical Endoscopy 38, no. 10 (2024): 6146–6155.
|
| [7] |
T. Keihanian, M. A. Khalaf, F. Z. Aloor, D. H. Zami, S. Jawaid, and M. O. Othman, “Transcecal Endoscopic Appendectomy for Management of Complex Appendiceal Polyps Extending Into the Appendiceal Orifice,” Endoscopy International Open 12, no. 8 (2024): E932–E939.
|
| [8] |
S. Mochizuki, N. Uedo, I. Oda, et al., “Scheduled Second-Look Endoscopy Is Not Recommended After Endoscopic Submucosal Dissection for Gastric Neoplasms (The SAFE Trial): A Multicentre Prospective Randomised Controlled Non-Inferiority Trial,” Gut 64, no. 3 (2015): 397–405.
|
| [9] |
L. Wang, Z.-Q. Liu, J.-Y. Zhang, et al., “Feasibility and Safety of Endoscopic Resection for the Jejunoileal Lesions,” Journal of Gastroenterology and Hepatology 39, no. 3 (2024): 527–534.
|
| [10] |
D. Yardeni, R. B. Hirschl, R. A. Drongowski, D. H. Teitelbaum, J. D. Geiger, and A. G. Coran, “Delayed Versus Immediate Surgery in Acute Appendicitis: Do we Need to Operate During the Night?,” Journal of Pediatric Surgery 39, no. 3 (2004): 464–469.
|
| [11] |
Y. Murao, S. Ueda, and S. Miyamoto, “Preoperative Administration of Antibiotics in Patients With Suspected Acute Appendicitis,” Surgery Today 26, no. 5 (1996): 314–322.
|
| [12] |
L. P. Cobben, A. M. de Van Otterloo, and J. B. Puylaert, “Spontaneously Resolving Appendicitis: Frequency and Natural History in 60 Patients,” Radiology 215, no. 2 (2000): 349–352.
|
| [13] |
R. T. Sebastian, J. Philip, S. Dutta Roy, and V. J. Sebastian, “Subserosal Appendicular Stripping,” International Journal of Surgery 5, no. 2 (2007): 86–88.
|
| [14] |
M. M. Moneer, “Avoiding Muscle Cutting While Extending McBurney's Incision: A New Surgical Concept,” Surgery Today 28, no. 2 (1998): 235–239.
|
| [15] |
H. S. Kim, H.-G. Kim, S. Y. Yang, et al., “Single-Incision Laparoscopic Surgery Compared to Conventional Laparoscopic Surgery for Appendiceal Mucocele: A Series of 116 Patients,” Surgical Endoscopy 36, no. 1 (2022): 244–251.
|
| [16] |
Y. Wang, M.-Y. Cai, S.-L. Lin, M.-F. Li, and P.-H. Zhou, “Transcolonic Endoscopic Appendectomy via Snare-Through-Line Resection for Stump Appendicitis,” Endoscopy 56, no. S01 (2024): E642–E643.
|
RIGHTS & PERMISSIONS
2026 The Author(s). Journal of Digestive Diseases published by Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.
PDF
(452KB)
